Li C, et al. - An inquiry was carried out of the abnormal nasal aerodynamics and trigeminal functions among empty nose syndrome (ENS) patients. Researchers carried out the first computational fluid dynamics (CFD) examination of nasal aerodynamics in ENS patients. A combination of loss of neural sensitivity and poorer inferior air-mucosal stimulation exhibited the potential ability to result in ENS symptomology.

Methods

• During this trial, individual computed tomography (CT)-based computational fluid dynamics (CFD) was applied to 27 ENS patients.
• The intent was to simulate their nasal aerodynamics. The yielded results were compared with 42 healthy controls.
• Patients’ symptoms were confirmed with Empty Nose Syndrome 6-item Questionnaire (ENS6Q), 22-item Sino-Nasal Outcome Test (SNOT-22), and Nasal Obstruction Symptom Evaluation (NOSE) scores.
• Researchers computed the nasal trigeminal sensitivity through the menthol lateralization detection thresholds (LDTs).

Results

• ENS patients reported markedly lower (∼25.7%) nasal resistance and higher (∼2.8 times) cross-sectional areas than the healthy controls (both p < 0.001).
• Regardless of the inferior turbinate reductions, CFD analysis disclosed that ENS patients had increased airflow concentrated in the middle meatus region (66.5% ± 18.3%) compared to healthy controls (49.9 ± 15.1%, p < 0.0001).
• The findings revealed considerably less airflow (25.8% ± 17.6%) and lower peak wall shear stress (WSS) (0.58 ± 0.24 Pa) in the inferior meatus (vs healthy: 36.5% ± 15.9%; 1.18 ± 0.81 Pa, both p < 0.05), with the latter exhibited a prominent connection with the symptom scores of ENS6Q (r = -0.398, p=0.003).
• Additionally, there was a vital link between the item-wise, complaints of “suffocation” and “nose feels too open” with peak WSS around the inferior turbinate (r = -0.295, p=0.031; and r = -0.388, p=0.004, respectively).
• Such associations were discovered to be negative, thereby, suggesting that less air-mucosal stimulations caused worse symptom scores.
• It was noted that the ENS patients (n = 12) displayed impaired menthol LDT when compared to healthy controls (p < 0.0001).